When Trauma-Informed Practice Meets the Medicolegal Process
We talk a lot about trauma-informed practice in psychiatric care—about creating safety, fostering trust, and recognising the pervasive effects of trauma on how people think, feel, and relate. But when it comes to a independent medicolegal assessment, that philosophy collides head-on with the very structure of the process itself.
A medicolegal psychiatric assessment is, by design, not trauma-informed. It’s evaluative. Time-limited. One-sided. Conducted within a system of power, scrutiny, and evidence. The person being assessed has little control over who assesses them, how questions are asked, or what becomes of their story. And yet, paradoxically, the trauma-informed mindset is never more necessary than in these moments. Not only to ensure that no harm is done, but to facilitate the ability to gather the information required to satisfy the professional and legal obligations expert witnesses need to maintain.
What Trauma-Informed Practice Actually Means
At its core, trauma-informed practice rests on five principles — safety, trustworthiness, choice, collaboration, and empowerment. It’s not about accepting every account as factual, but about understanding how trauma shapes the way people tell their stories.
Someone who has lived through abuse or institutional betrayal often carries a deep imprint of powerlessness. They have learned that authority is unsafe, that being questioned means being doubted, and that recounting the past can reopen the same wounds of helplessness.
In an independent medicolegal assessment, those dynamics are easily re-activated. The psychiatrist holds institutional authority; the examinee feels observed and scrutinised. The questions can feel interrogative. The process itself — necessary for legal fairness — risks becoming a replay of the very power imbalance that caused harm.
Why the Medicolegal Assessment Is Inherently Not Trauma-Informed
A independent medicolegal assessment is not a therapy session, and cannot be. The assessor’s role is to form an independent opinion, whilst upholding their professional and legal obligations to the court process.
This means:
The claimant doesn’t choose the assessor or the purpose of the meeting.
The psychiatrist determines the pace, the scope, and the relevance of each detail.
Questions must sometimes probe inconsistencies with historical documents or other professional observations — an act that, however gently done, can feel like disbelief.
The written report becomes a document that may later be scrutinised in court, often without the claimant’s input.
Every element of that process runs counter to the trauma-informed principles of choice, collaboration, and empowerment.
And yet, these constraints do not absolve us of the responsibility to minimise harm within them.
Being Trauma-Informed Within the Constraints
To practise trauma-informed psychiatry in the medicolegal space is to work with awareness of power, not the illusion of its absence.
It means:
Explaining the process transparently before starting.
Using neutral, non-pathologising language (“described” rather than “claimed”).
Acknowledging distress, pacing questions when possible and offering breaks.
Recognising avoidance or hypervigilance as potentially trauma-related, not oppositional.
A trauma-informed assessor does not sacrifice rigour for compassion — but neither do they use rigour to justify disregard. They understand that trauma is both psychological and procedural: that how we ask can matter as much as what we find.
The Paradox We Must Hold
The medicolegal process is built on judgement, while trauma-informed care is built on understanding. Bringing those two worlds together requires intellectual humility: to recognise that even as we assess objectively, we are operating within a framework that can easily perpetuate the very dynamics we are describing.
Ultimately, trauma-informed medicolegal psychiatry is not about being soft — it’s about being aware.
Aware of the power we hold.
Aware of how that power feels to someone who has lived its abuse.
And aware that the fairest, most defensible opinion is one that sees both the evidence and the person who sits behind it.